3 Introduction This publication contains information about how long children and young people waited for mental health services provided by the NHS in Scotland. It is the third time that this information has been published. The information in this publication covers the period October to December 2012, with figures from July to September 2012 for reference. The NHS in Scotland provides mental health services for children and young people with a wide rage of mental health conditions including Attention Deficit Hyperactivity Disorder (ADHD), anxiety, behaviour problems, depression and early onset psychosis. This treatment is provided through Child and Adolescent Mental Health (CAMH) services. These services, which are mainly outpatient and community based, are provided by a range of staff including psychiatrists, mental health nurses, clinical psychologists, child psychotherapists, occupational therapists and other allied health professionals. The Scottish Government requires the NHS in Scotland to measure the time people wait for treatment and this includes people waiting for CAMH services. The Scottish Government has set a target for the NHS in Scotland to deliver a maximum 26 week waiting time from a patient s referral to treatment for specialist CAMH services from March 2013, reducing to 18 weeks from December Following the conclusion of previously planned work on a tolerance level for CAMH service waiting times and engagement with NHS Boards and other stakeholders, the Scottish Government has determined that the CAMH services target should be delivered for at least 90% of patients. The systems for collecting data locally are still being developed and as a result some people who attended a CAMH service are not included in this publication. However the information in this publication does give a good indication of waiting times in most areas of Scotland. Over the coming months, we expect to increase the volume of information that we can collect from NHS Boards. 2

4 Key points Waiting times information for CAMH services is still at an early stage of development. NHS Boards are working with ISD and the Scottish Government to improve the consistency and completeness of the information. The target is due for delivery from March To report on CAMHS waiting times, NHS Boards have had to develop, for the first time, systems to report on CAMHS waiting times. During the quarter ending December 2012, almost 3,200 children and young people started treatment at CAMH services in Scotland. The initial estimates from data at an early stage of development indicate that around 91% of people were seen within 26 weeks. 3

5 Results and Commentary Adjustment of waiting times Waiting times for most NHS services are worked out using a calculation that takes into account any periods a person is unavailable and missed or cancelled appointments. These are referred to as adjustments. Some NHS Boards are not able to make all the appropriate adjustments to waiting times for CAMH services so we have included information on what adjustments each NHS Board has made. Waiting time adjustments allow fair reporting of waiting times which have been affected by factors outside the NHS Board s control. However the timing of appointments is always based on clinical need. For CAMH services, resetting the waiting time to zero is done for reporting purposes only and does not impact on the timing of any further appointments. The main adjustments that are made to CAMH services waiting times are: If a person is unavailable (for example on holiday), the period for which they are unavailable is subtracted from their total waiting time. If a person does not attend an appointment and has to be given another their waiting time is reset to zero. If a person rearranges an appointment their waiting time is reset to zero on the day they contact the service to rearrange their appointment. If a person is offered several appointments and declines them all their waiting time is reset to zero. NHS Boards report that this happens very rarely as most appointments are agreed by telephone. This report also shows unadjusted waiting times. These are the actual times people have waited. Unadjusted waiting times are not available for all NHS Boards. 4

6 How long people waited to start their treatment This section shows waiting times for patients who started their treatment during the period October - December During that period (see Table 1): Almost 3,200 children and young people started their treatment at CAMH services in Scotland. Using adjusted waits where available, 91% of people seen by a CAMH service started their treatment within 26 weeks of being referred. Half of people started their treatment within 7 weeks. In the NHS Boards that are able to report unadjusted waits, 90% of people seen by a CAMH service started their treatment within 26 weeks of being referred. Half started their treatment within 8 weeks. There has been a slight increase in the percentage of people seen within 26 weeks this quarter compared to the quarter July - September 2012 (Chart 1). However data for successive months are not strictly comparable due to ongoing development of information systems, so small changes from one month to the next should not be interpreted as a significant rise or drop in performance at this stage. We expect to be able to make more accurate comparisons in future publications. Information by NHS Board is shown in Tables 2 and 3 and Chart 2. Table 1. Waiting times for people who started their treatment in October December 2012, NHS Scotland (excluding NHS Grampian) Month People seen With adjustments 1 Unadjusted 2 Seen within 26 weeks (%) Average weeks waited (median) Seen within 26 weeks (%) Average weeks waited (median) October ,083 91% 7 89% 9 November ,236 91% 7 90% 8 December % 6 90% 7 Total 3,166 91% 7 90% 8 Notes 1. Includes unadjusted waits for NHS Boards where adjusted waits are not available. 2. Excludes NHS Dumfries and Galloway where unadjusted waits are not available. 5

10 People waiting at the end of the month This section presents a summary of waiting times information for CAMH services for people who are waiting at the end of each month. This is a useful measure for managers of these services as it can help them take early action to ensure that patient waits do not exceed the target. However this measure does not show how long people actually wait before they received care. At the end of December 2012 (Table 4): Around 3,900 people were waiting to start treatment at CAMH services in Scotland. Using adjusted waits where available, 205 of these had been waiting for more than 26 weeks. In the NHS Boards that are able to report unadjusted waits, 242 of these had been waiting for more than 26 weeks. The number of people waiting has increased over the quarter, but the percentage of people waiting less than 26 weeks has remained the same. However data for successive months are not strictly comparable due to ongoing development of information systems, so small changes from one month to the next should not be interpreted as a significant rise or drop in performance. We expect to be able to make more accurate comparisons in future publications. Information by NHS Board is shown in Chart 4 and Tables 5 and 6. Table 4. Waiting times for people waiting at the end of the month in Scotland Month End Total People Waiting More than 26 weeks Less than 26 weeks (%) (number) With adjustments 1 Unadjusted 2 With adjustments 1 Unadjusted 2 October ,647 93% 93% November ,781 94% 93% December ,897 95% 94% Notes 1. Includes unadjusted waits for NHS Boards where adjusted waits are not available. 2. Excludes NHS Dumfries & Galloway. 9

11 Chart 3. Percentage of people waiting less than 26 weeks, NHS Scotland, July December With adjustments Unadjusted waits 20 0 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Month end 1. Waiting time adjustments: NA: Non Attendance. Waiting time may be reset if a person misses or rearranges an appointment. U: Unavailability. Time a person is unavailable may be subtracted from the waiting time. RO: Refuses Reasonable Offer. Waiting time may be reset if a person declines 2 or more dates. For further information see page Includes unadjusted waits for NHS Boards where adjusted waits are not available. 3. Unadjusted data excludes NHS Ayrshire & Arran (July to September 2012) and NHS Dumfries & Galloway (July to December). Chart 4. Percentage of people waiting less than 26 weeks by NHS Board, 31 December 2012 NHS Ayrshire & Arran NHS Borders NHS Dumfries & Galloway NHS Fife NHS Forth Valley NHS Grampian NHS Greater Glasgow & Clyde waits Unadjusted waits NHS Highland NHS Lanarkshire NHS Lothian NHS Tayside NHS Orkney, NHS Shetland and NHS Western Isles 0% 20% 40% 60% 80% 100% Notes 1. Waiting time adjustments: NA: Non Attendance. Waiting time may be reset if a person misses or rearranges an appointment. U: Unavailability. Time a person is unavailable may be subtracted from the waiting time. RO: Refuses Reasonable Offer. Waiting time may be reset if a person declines 2 or more dates. For further information see page Due to small numbers, NHS Orkney, NHS Shetland and NHS Western Isles have been combined. 10

14 Number of people referred to CAMH Services This section has information on how many children and young people are referred to CAMH services. Waiting lists can build up where demand for services exceeds the capacity of that service, so the number of referrals is a key measure for managing waiting times. During the period October - December 2012 around 6,500 children and young people were referred to CAMH services. The number of referrals by NHS Board are shown in Table 7. However please note that this information is developmental and may contain inaccuracies. We expect the quality of data to improve over the coming months. It is not possible to give a direct comparison of referral rates across the NHS Boards as CAMH services vary in the age of population served. Some areas provide services for all those under 18, while others offer services to those over 16 only if they are in full time education (for more detail see Workforce Information). The referrals per 1,000 people under 18 give an indication of the relative differences in demand. 13

16 Glossary CAMH services These are the Child and Adolescent Mental Health (CAMH) services provided by NHSScotland. Services are provided by teams of clinicians including psychiatrists, mental health nurses, clinical psychologists, child psychotherapists, occupational therapists and other allied health professionals. These services are based mainly in outpatient clinics and in the community. Children and young people These are the people served by CAMH services. Some areas provide services for all those under 18, while others offer services to those over 16 only if they are in full time education (for more detail see Workforce Information). Start of treatment This is when treatment starts or the person is removed from the waiting list. Not all people who are referred to a CAMH service go on to have treatment. Some people attend an assessment appointment, need no further treatment and so are removed from the waiting list. Some people are offered treatment but decide not to go ahead. waiting time This is how long a person waited after taking into account any periods they were unavailable and any appointments that they missed or rearranged. The adjustments are described on Page 4. If a person has no periods of unavailability and attends on the first date that they accept then no adjustments are made and their adjusted waiting time is the same as their unadjusted waiting time. Unadjusted waiting time The total time from the date the referral was received by the CAMH service to the date treatment commenced. HEAT targets A set of targets agreed between the Scottish Government and NHSScotland relating to Health Improvement, Efficiency, Access or Treatment (HEAT). 15

17 List of Tables Table No. Name Time period File & size 1 Completed waits for people seen July 2012 December Excel [732kb] Unadjusted Completed waits for people July Excel [725kb] seen December Waiting times for people waiting July Excel [732kb] December Unadjusted waiting times for people waiting July Excel [721kb] December Referrals July December 2012 Excel [692kb] Note: in order to view the tables to full effect, your macro security settings will need to be set to medium. To change macro security settings using Tools, Macro, Security - set security level to Medium and re-open the report. 16

18 Contact Amy McKeon Principal Information Analyst Mhairi Boyd Senior Information Analyst CAMHS Waiting Times Team Further Information Further information can be found on the ISD website Rate this publication Click here to provide feedback and rate this publication. 17

19 Appendix A1 Background Information Why are waiting times important? The main function of CAMH services is to develop and deliver services for those children and young people (and their parents and carers) who are experiencing the most serious mental health problems. They also have an important role in supporting the mental health capability of the wider network of children s services. Delivery of good quality CAMH services depends on timely access to healthcare. Early action is more likely to result in full recovery and, in the case of children and young people, minimises the impact on other aspects of their development such as their education, so improving their wider social development outcomes. Mental Health Policy and Targets Developments in mental health care have been driven by a series of reports and policy recommendations: The Scottish Needs Assessment Programme (SNAP) Report on Child and Adolescent Mental Health (2003) highlighted the importance of CAMH services and the need for development of these services within Scotland. Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care (Scottish Executive, 2005) set the policy direction and a commitment to developing these services. A HEAT target for CAMH services was set in April The target is that no child or young person will wait longer than 26 weeks from referral to treatment in a specialist CAMH service from March 2013, reducing to 18 weeks from December Following the conclusion of previously planned work on a tolerance level for CAMH service waiting times and engagement with NHS Boards and other stakeholders, the Scottish Government has determined that the CAMH services target should be delivered for at least 90% of patients. The Mental Health Strategy for Scotland: (2012) sets the policy direction for the next four years and includes a commitment to achieving and maintaining waiting times targets. Workforce Information CAMH Workforce Information (2012) presents the latest information on numbers of clinical staff working in CAMH Services. 18

20 A2 Data Quality CAMHS waiting times data has been collected nationally from January 2010, although initially data was very incomplete and of poor quality. There have been significant improvements in data quality and completeness over time, but some systems for collecting data locally are still being developed and as a result the data is not yet complete. Over the coming months, we expect the quality and completeness of data to continue to improve. Data completeness by NHS Board is shown on Page 20. and unadjusted waiting times It is not possible to report nationally consistent data at Scotland level due to the differences in adjustments made to waiting times across the NHS Boards. When the HEAT target was announced, NHS Boards were asked to adjust waiting times where patients were unavailable or did not attend an appointment and had to be given another. This New Ways calculation of wait is used in other NHS services such as inpatients, outpatients and audiology. Some NHS Boards developed systems to enable this calculation for CAMH services. However not all systems are able to make all the appropriate adjustments, so all data which includes adjusted figures also includes information about what adjustments have been applied. With the exception NHS Dumfries and Galloway, all NHS Boards which adjust data also report unadjusted waiting times. Data completeness: common issues Waiting times data is extracted from local administration systems which are updated frequently with information about appointments, attendances etc. This may lead to different reported numbers of patients seen or waiting depending on the date the data was extracted. However any differences equate to a relatively small proportion of total numbers of patients seen or waiting. Data quality issues by NHS Board This section lists any quality issues with data held by ISD. For data completeness see Page

22 A3 Publication Metadata (including revisions details) Metadata Indicator Publication title Description Theme Topic Format Data source(s) Date that data are acquired Release date Frequency Timeframe of data and timeliness Continuity of data Revisions statement Revisions relevant to this publication Concepts and definitions Relevance and key uses of the statistics Description Child and Adolescent Mental Health Services Waiting Times Times/Child-and-Adolescent-Mental-Health/ Monthly and quarterly summary of waiting times and waiting lists for Child and Adolescent Mental Health Services Health and Social Care Access and Waiting Times Excel workbooks Aggregate counts accredited and derived from individual NHS Scotland Boards are submitted monthly to ISD using a defined Excel template. Deadline for data submission is the 24th of each month, though files can be resubmitted up to 3 weeks before publication where the quality assurance process identifies differences with local figures. The last Tuesday of the month for each publication Quarterly Data up to December 2012 is included. Information has been collected nationally since January 2010 with a revised dataset introduced in April Monthly information is included in the report for the last six months. Previously published waiting times are revised at each publication to reflect the latest available data submitted to ISD by the NHS Boards. NHS Ayrshire & Arran have resubmitted referral figures for July to September 2012 quarter so these will have changed from the previously published data. Information on the number of referrals was previously only shown for the total number of referrals excluding rejected referrals. The total number of referrals and the total number (excluding rejected referrals) have been included in this publication. Definitions not contained in this report are available here. Waiting times are important to patients and are a measure of how the NHS is responding to demands for services. Measuring and regular reporting of waiting times highlights where there are delays in the system and enables monitoring of the effectiveness of NHS performance throughout the country. The NHS in Scotland has been set a number of targets for maximum waiting times. 21

23 Accuracy Completeness Comparability Accessibility Coherence and clarity Value type and unit of measurement Disclosure Official Statistics designation UK Statistics Authority Assessment Last published 27 November 2012 Next published 28 May 2013 Date of first publication 28 August 2012 Help Date form completed 26 February 2013 Other uses of the data include information requests for a variety of customers, e.g. research charities; public companies; Freedom of Information requests; information support to Boards; health intelligence work; parliamentary questions and HEAT targets. These data are classified as developmental. ISD only receives aggregate data from each NHS Board. Although aggregated data cannot be systematically validated by ISD, reported data are compared to previous figures and to expected trends. Derivation of the figures and data accuracy are matters for individual NHS Boards. 100% of submitted data is used for analysis and publication. Comparative waiting times information is not possible at present using these data due to inconsistencies in definitions of waiting times for treatment across the four nations. Collaborative efforts by the health departments of the four nations to produce comparable figures on waiting times is currently underway by the UK Comparative Waiting Times Group. It is the policy of ISD Scotland to make its web sites and products accessible according to published guidelines. Key statistics for the latest quarter are linked to on the main Waiting Times page Topics/Waiting-Times/. Statistics are presented within Excel spreadsheets. NHS Board and national figures are presented. Further features to aid clarity: 1. Tables are printer friendly. 2. Key data presented graphically. Number and percentage of patients seen, number and percentage of patients waiting, median and 90 th percentile waits; by NHS Board. The ISD protocol on Statistical Disclosure Protocol is followed. Official Statistics Awaiting assessment 22

24 A4 Early Access details (including Pre-Release Access) Pre-Release Access Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", ISD are obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access. Standard Pre-Release Access: Scottish Government Health Department NHS Board Chief Executives NHS Board Communication leads Extended Pre-Release Access Extended Pre-Release Access of 8 working days is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access). Scottish Government Health Department (Analytical Services Division) 23

25 A5 ISD and Official Statistics About ISD Scotland has some of the best health service data in the world combining high quality, consistency, national coverage and the ability to link data to allow patient based analysis and follow up. Information Services Division (ISD) is a business operating unit of NHS National Services Scotland and has been in existence for over 40 years. We are an essential support service to NHSScotland and the Scottish Government and others, responsive to the needs of NHSScotland as the delivery of health and social care evolves. Purpose: To deliver effective national and specialist intelligence services to improve the health and wellbeing of people in Scotland. Mission: Better Information, Better Decisions, Better Health Vision: To be a valued partner in improving health and wellbeing in Scotland by providing a world class intelligence service. Official Statistics Information Services Division (ISD) is the principal and authoritative source of statistics on health and care services in Scotland. ISD is designated by legislation as a producer of Official Statistics. Our official statistics publications are produced to a high professional standard and comply with the Code of Practice for Official Statistics. The Code of Practice is produced and monitored by the UK Statistics Authority which is independent of Government. Under the Code of Practice, the format, content and timing of statistics publications are the responsibility of professional staff working within ISD. ISD s statistical publications are currently classified as one of the following: National Statistics (ie assessed by the UK Statistics Authority as complying with the Code of Practice) National Statistics (ie legacy, still to be assessed by the UK Statistics Authority) Official Statistics (ie still to be assessed by the UK Statistics Authority) other (not Official Statistics) Further information on ISD s statistics, including compliance with the Code of Practice for Official Statistics, and on the UK Statistics Authority, is available on the ISD website. 24

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